Chronic oral anticoagulant therapy for extrahepatic visceral thrombosis is safe |
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Authors: | Craig S Kitchens Molly H Weidner Richard Lottenberg |
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Institution: | (1) Malcom Randall Veterans Administration Medical Center, 1601 SW Archer Road, Gainesville, FL 32608, USA;(2) Department of Medicine, Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, FL, USA |
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Abstract: | Background Patients with hypercoagulability may thrombose visceral veins with resultant portal hypertension, esophagogastric varices,
and hemorrhage. The role of chronic oral anticoagulant therapy in such patients is unclear. On the one hand, such patients
are prone to significant hemorrhage and thus anticoagulant therapy may seem contraindicated. On the other hand, because the
causal pathophysiology is typically hypercoagulability, it would seem rational to treat these patients with chronic anticoagulant
therapy in order to both prevent other visceral and systemic thromboses and perhaps, over time, reduce the degree of portal
hypertension. Experience and poor prognosis associated with the more common portal hypertension due to hepatic cirrhosis may
bias judgment.
Methods We retrospectively reviewed the course of chronic oral anticoagulant therapy regarding both the safety and effectiveness using
our long-term follow-up of a cohort of seven patients with visceral thrombosis resulting in extrahepatic non-cirrhotic portal
hypertension.
Results Seven consecutive patients encountered over the past 19 years were observed for 78 patient-years, the first 14 patient-years
prior to anticoagulant therapy and the latter 64 patient-years on oral anticoagulant therapy. No patients rethrombosed either
visceral or systemic vessels while on oral anticoagulant therapy. There were no fatal or serious hemorrhagic events on oral
anticoagulant therapy; in fact, upper gastrointestinal bleeding decreased from 1.2 to 0.2 bleeds/year. The endoscopic grade
of esophageal varices decreased in four of five patients who underwent serial endoscopy, and platelet counts increased in
all seven patients.
Conclusions Chronic oral anticoagulant therapy is safe and not associated with an increase in upper gastrointestinal bleeding in such
patients. Additionally, and by inference, perhaps in conjunction with the natural history of portal hypertension, such therapy
is possibly effective in reducing portal hypertension in patients with hypercoagulability-induced extrahepatic portal hypertension.
Condensed Abstract The safety and role of chronic oral anticoagulant therapy in the long-term management of extrahepatic esophageal varices
is unclear. We followed seven patients with hypercoagulability-induced visceral thrombosis for a total of 78 patient-years.
Our data show that this was safe, associated with an overall decrease in acute upper gastrointestinal hemorrhagic episodes,
and perhaps, in a decrease in portal hypertension. |
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Keywords: | Anticoagulation Venous thrombosis Extrahepatic portal hypertension Hypercoagulability |
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